IV: 6 mg/kg IV q12h x 2 doses then 4 mg/kg IV q12h
PO : 400 mg PO q12h x 2 doses then 200 mg PO q12h
Dose reduction may be required if low body weight.
0 - 50 eGFR50+ eGFRIV formulation not recommended due to accumulation of vehicle (cyclodextrin), switch to oral. No dose modification needed.No dose adjustment required.
Severe impairment (Child-Pugh C) - Should only be used if benefit outweighs risk
Mild to moderate (Child-Pugh A/B) - Standard loading dose then reduce maintenance by 50%
Candida infections both mucocutaneous and invasive - i.e. Candidemia
Antifungal prophylaxis in immunocompromised
Single case report in human pregnancy (after 19 wga), normal healthy baby
Animal data suggest teratogenicity
Caution due to data from fluconazole (see fluconazole entry)
Therapeutic drug monitoring may be helpful to ensure adequate concentrations and exclude toxicity
QTc interval in patients at elevated risk
Monitor hepatic profile
Creatinine, electrolytes (K+, Mag+, Ca+)
Hepatotoxicity, renal toxicity
Rash; dermatologic reactions
Visual disturbance, photophobia, headache, dizziness,
Multiple significant drug interactions, consult pharmacy.
CYP450 interactions ++
Other QTc prolonging agents
Contraindicated with pimozide, quiniDINE, rifampin, carbamazepine, sirolimus, rifabutin, ritonavir, efavirenz, ergot alkaloids, and phenobarbital
Voriconazole may inhibit the metabolism of tacrolimus (need to decrease tacrolimus dose to 1/3 of original dose), cycloSPORINE (need to decrease cycloSPORINE dose by 50%), sulphonylureas, statins, and HIV protease inhibitors other than indinavir
Voriconazole increases concentration of phenytoin. Phenytoin decreases concentration of voriconazole. Drug monitoring recommended.
Recommend review of patient medications due to high frequency of significant interactions
Food may decrease oral absorption. Should be taken 1hr before or 1 hr after a meal
Avoid/limit use of IV formulation in renal failure due to accumulation of vehicle (cyclodextrin)
Infectious Disease consult strongly recommended.
Antimicrobial class: Triazole antifungal, second generation.